Calif. surgeon accused of prescribing excessive drugs to disabled man

Below:

LOS ANGELES — A transplant surgeon accused of hastening the death of a man so his organs could be harvested has been ordered to trial on one count of felony dependent adult abuse, but two other felony charges involving administration of drugs to the dying man were dismissed.

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

The criminal case against Dr. Hootan Roozrokh of San Francisco is the first such action against a transplant doctor in the United States.

After a preliminary hearing in San Luis Obispo County, Superior Court Judge Martin J. Tangeman issued a ruling Wednesday describing an uncoordinated scene surrounding the 2006 death of Ruben Navarro at Sierra Vista Regional Medical Center, which had never handled a “Donation After Cardiac Death (DCD)” case.

Navarro, 26, had a debilitating neurological disease and was in a coma when he was admitted to the hospital after a heart attack.

His mother had authorized harvesting of his organs but because he was not brain dead, the judge said, it was determined that the transplant procedure to be used would be DCD, which requires withdrawal of life support leading to death prior to recovery of organs.

“Dr. Roozrokh did not make or participate in making any of these decisions,” said the ruling, which added that Roozrokh was sent by employer Kaiser Permananente in coordination with the California Transplant Donor Network to perform the transplant surgery after those decisions were made.

Long line of missteps
But the judge said doctors and nurses present when Navarro died gave conflicting accounts and “the inconsistencies in testimony between the various witnesses cannot be resolved by reference to written records.”

His ruling cited the lack of experience in the procedure by everyone involved including Roozrokh, who was less than a year out of his organ transplant fellowship and had observed only one such procedure in training.

Roozrokh is the only person charged criminally in the case. His attorney, M. Gerald Schwartzbach, told The Associated Press he was disappointed the entire case was not dismissed.

“I’m extremely confident that at the end of trial Dr. Roozrokh will be both vindicated and admired. Even if he did everything they said, he was a hero. He saved this man from pain. ... He tried to ensure this young man died pain free. That’s all he did,” Schwartzbach said Thursday.

Schwartzbach said testimony at the preliminary hearing showed that “the entire system failed.”

The judge, in a section of his decision entitled “The absence of experience and guidelines in DCD procedures in 2006,” appeared to agree. He highlighted a long line of missteps and noted there was no national DCD protocol in place and the hospital did not have a written DCD protocol.

The prosecutor commented briefly on the ruling.

“The evidence has spoken and we will continue to present our case in court,” said San Luis Obispo County Deputy District Attorney Karen Gray.

Lost recordsIn his account of testimony, Tangeman said Roozrokh was accompanied to the hospital on Feb. 3, 2006, by an experienced transplant doctor, but he too had never participated in such a procedure.

No one kept a chart of medications administered to Navarro in the operating room, the ruling said, and four witnesses gave different accounts on how many doses of the painkillers morphine and Ativan were given. While various witnesses testified to their observations of Navarro’s vital signs, the judge said the transplant coordinator claimed to have lost the records.

The judge said there was no evidence Roozrokh administered or ordered a combination of Betadine, morphine and Ativan for Navarro. He dismissed one count which included that allegation. He also dismissed a count alleging “unlawful controlled substance prescription.”

State law prohibits transplant doctors from directing treatment of potential organ donors until they are declared dead.

The judge said no attending physician was available at the hospital and “no medication for comfort care or withdrawal of life support was available in the operating room” when Navarro arrived.

“When the attending physician finally arrived in the operating room, all other participants were already there and she failed to understand that she was the responsible physician in charge of ordering medications,” the judge wrote.

The attending physician, Dr. Laura Lubarsky, was granted immunity from prosecution for her testimony. The judge noted that she testified “other than being responsible for declaring death, she believed that her role was limited to being an observer.”

Navarro’s organs were not successfully harvested.

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.